Unique Characteristics of Epilepsy Development in Neurocysticercosis.

The parasitic helminth infection neurocysticercosis (NCC) is the most common cause of adult-acquired epilepsy in the world. Despite the serious consequences of epilepsy due to this infection, an in-depth review of the distinct characteristics of epilepsy due to neurocysticercosis has never been conducted. In this review, we evaluate the relationship between NCC and epilepsy and the unique characteristics of epilepsy caused by NCC. We also discuss recent advances in our understanding of NCC-related epilepsy, including the importance of anti-inflammatory therapies, the association between NCC and temporal lobe epilepsy, and the recent discovery of biomarkers of severe epilepsy development in individuals with NCC and seizures.

An economic analysis of outcomes and complications of treating distal radius fractures in the elderly.

PURPOSE: There is a lack of scientific data regarding which treatment provides the best outcome for distal radius fractures (DRFs) in the elderly. Currently, casting is used to treat the majority of these fractures, although open reduction and internal fixation (ORIF) has been used increasingly in recent years. Given the recent emphasis on the wise use of medical resources, we conducted a cost-utility analysis to assess which of 4 common DRF treatments (casting, wire fixation, external fixation, or ORIF) optimizes the cost-to-patient preference ratio. METHODS: We created a decision tree to model the process of choosing a DRF treatment and experiencing a final outcome. Fifty adults aged 65 and older were surveyed in a time trade-off, one-on-one interview to obtain utilities for DRF treatments and possible complications. We gathered Medicare reimbursement rates and calculated the incremental cost-utility ratio for each treatment. RESULTS: Participants rated DRF treatment relatively high, assigning utility values close to perfect health to all treatments. The ORIF was the most preferred treatment (utility, 0.96), followed by casting (utility, 0.94), wire fixation (utility, 0.94), and external fixation (utility, 0.93). The ORIF was the most expensive treatment (reimbursement, $3,516), whereas casting was the least expensive (reimbursement, $564). The incremental cost-utility ratio for ORIF, when compared to casting, was $15,330 per quality-adjusted life years, which is less than $50,000 per quality-adjusted life year, thereby indicating that, from the societal perspective, ORIF is considered a worthwhile alternative to casting. CONCLUSIONS: There is a slight preference for the faster return to minimally restricted activity provided by ORIF. Overall, patients show little preference for one DRF treatment over another. Because Medicare patients pay similar out-of-pocket costs regardless of procedure, they are not particularly concerned with procedure costs. Considering the similar long-term outcomes, this study adds to the uncertainty surrounding the choice of DRF treatment in the elderly, further indicating the need for a high-powered, randomized trial.

A systematic review of interethnic variability in facial dimensions.

BACKGROUND: The earliest recorded facial proportional analysis is in the Greek neoclassical canons (c. 450 b.c.). In contemporary times, there has not yet been a study that describes the relative differences in facial proportions among the world's different ethnic groups. The specific aim of this project was to perform a systematic review of data from the existing literature to evaluate the degree of variability in the facial dimensions among various ethnic groups. METHODS: A PubMed database review identified primary articles containing measurements of facial proportions from various ethnic groups. These facial measurements included the heights and widths of the upper, middle, and lower face, which are the features originally described by the neoclassical canons. Coefficients of variation were calculated to derive a unit-free comparison of the degree of variability among different ethnic groups in each of the neoclassically measured facial dimensions. RESULTS: The authors' literature search identified 239 potential articles. After screening for the inclusion and exclusion criteria, seven relevant articles were selected. These articles contained data on 11 linear facial measurements from 2359 male and female individuals from 27 different ethnic groups; features that demonstrated the largest differences among the different ethnic populations were forehead height, interocular distance, and nasal width. CONCLUSIONS: The greatest interethnic variability in facial proportions exists in the height of the forehead. More pronounced differences among the ethnic groups are also present in the measurements of the eyes, nose, and mouth. There is no significant difference between sexes in the neoclassical facial proportions.

Maintenance of Certification, maintenance of public trust.

The Maintenance of Certification program has been well received by many physicians but has faced significant opposition from others who complain that it is overly tedious, costly, and irrelevant to their practice. This article offers a consolidated and concise history of the program and a summary of what plastic surgeons need to know to successfully complete the American Board of Plastic Surgery's own Maintenance of Certification requirements. The authors have justified each step of the board's Maintenance of Certification process in terms of how it improves the quality of care delivered to plastic surgery patients. Finally, a summary of research is presented that demonstrates both that the public supports the maintenance of certification process for all physicians and that continuing education and formal assessment and improvement initiatives have been linked in multiple studies to a better and more evidence-based medical practice.

Historical perspective on the etiology of rheumatoid arthritis.

Contributions of historical analyses to the development of a cogent etiologic theory of rheumatoid arthritis (RA) have been limited to date. In this article, the authors analyze this literature with respect to the types and conclusions of the research that has been conducted, present the major points of evidence and conclusions that have been drawn, and trace the evolution of 3 historical theories of RA. The authors combine a comprehensive overview of paintings and paleopathological investigations with consideration of contemporary immunologic and genetic studies.

Optimal management of carpal tunnel syndrome.

In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS) published a guideline for treatment of carpal tunnel syndrome (CTS) in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients' symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies should include cost analyses to help determine the cost burden of CTS.

A systematic review of the relationship between plastic surgery and the medical industry.

BACKGROUND: The nature and extent of medicine's relationship with the medical industry is currently a heated issue in medicine. Although the ethical implications of this relationship have been widely discussed in medical journals and the popular media, it is unknown how the current interest in industry issues has affected plastic surgery. The aim of this systematic review was to characterize the literature of the past two decades that examines plastic surgery's relationship with the medical industry. METHODS: Three medical databases were searched using plastic surgery and industry-related search terms. The quality of selected articles was assessed by two reviewers. The specific data abstracted included the venue of the industry interaction discussed within the article: (1) physician education programs, (2) research partnerships, and (3) clinical settings. Within each of these categories, a comprehensive taxonomy was created to categorize the thematic content of the articles' discussions. RESULTS: Of the 465 articles gleaned by the search, 21 met the inclusion and exclusion criteria and were included in the final review. All 21 articles were of a review or editorial nature, and the majority (57 percent) discussed the nature or effects of industry's presence within the clinical setting. CONCLUSIONS: This systematic review revealed the literature's cursory analysis of plastic surgery's relationship with the medical industry. This project highlighted the need for plastic surgery to examine the ethical implications of industry's support and engagement within the field. Improving this literature is necessary for plastic surgeons to understand and adhere to current standards on acceptable practices.

A systematic review of applying patient satisfaction outcomes in plastic surgery.

BACKGROUND: The authors performed a systematic review of patient satisfaction studies in the plastic surgery literature. The specific aim was to evaluate the status of satisfaction research that has been undertaken to date and to identify areas for improvement. METHODS: Four medical databases were searched using satisfaction and plastic surgery-related search terms. Quality of selected articles was assessed by two trained reviewers. RESULTS: Of the total of 2936 articles gleaned by the search, 178 were included in the final review. The majority of the articles (58 percent) in our review examined patient satisfaction in breast surgery populations. In addition, 53 percent of the articles were limited in scope and only measured features of care in one or two domains of satisfaction. Finally, the majority of the studies (68 percent) were based solely on the use of ad hoc satisfaction measurement instruments that did not undergo formal development. CONCLUSIONS: Given the important policy implications of patient satisfaction data within plastic surgery, we found a need to further refine research in this area. The scarcity of satisfaction research in the craniofacial, hand, and other reconstructive specialties, the narrow scope of satisfaction measurement, and the use of unvalidated instruments are current barriers preventing plastic surgery patient satisfaction studies from producing meaningful results.

A historical perspective of the Notta's node in trigger fingers.

Trigger finger is a condition that can result from a stenosed digital flexor tendon sheath. The condition was first described by French physician Alphonse Notta in 1850 in a report that consisted of 4 case studies of adult patients. Notta's and other reports written in the 19th century document the early views on this condition's etiology and management. The 20th century saw the development of modern-day treatment methods for the condition, namely corticosteroid injections and the surgical release of the A1 pulley.